Spatio temporal 2

Endemic canine rabies is a reemerging neglected zoonosis often underestimated in Kenya but remains a public health and economic burden to the rural poor. Understanding the transmission dynamics and distribution of dog bites over specified time period can assist in assessment of risk factors, design of interventions to exposure and the estimation of rabies burden

irregular dispersal pattern Clustering around hospital may be due to KAP of urban population enhances reporting, Accessibility determined by semipermeable barriers, An association of increased risk for canine rabies and areas of low socio-economic status coupled with lower vaccination coverage and increased densities of unrestrained dogs are strongly associated with poorer urban and rural areas. On visual inspection, the highest (30%, 95% CI 14-52% N = 45) densities of dog bites were in areas around the central place of the study area, bites clustered in not more than 15km radius from the hospital. The second cluster centered around Lubao dog market 7.4 %( 95% CI, 5-12%, N = 11). 12% of the bites were along roads and rivers while 5% occurred in and around forests

Annual increase in reporting can be attributed to increased public sensitivity and awareness to Rabies through the veterinary department. Improved economic status of the local people led to affordability of Medicare and hence hospital attendance. Ultimately the pragmatic utility of a hospital records provides an avenue for accountability and policy revisions in funding of neglected tropical diseases. The trend reflects the probable range with the given data, but the true level may actually be even higher because of lack of accurate denominator data due to poor methodologies in capture of quality clinical data, lack of awareness and unreported cases.

contributes to skewed or subjective analysis. Lack of updated national census data leads to hence

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<ul><li>BACKGROUND </li></ul><ul><li>ETIOLOGY OF BITES: Dog bites result from imperfect relationship between humans and animals. These can result in physical and psychological trauma, wound infections, septicemia, rabies and death ( Sinclair and Zhou, 1995 ). </li></ul><ul><li>EPIDEMIOLOGICAL TRIAD </li></ul><ul><li>EPIDEMIOLOGICAL BURDEN : Dog bites are a significant public health problem due to mortality and morbidity (DALYS, YLL). </li></ul><ul><li>REEMERGING /EMERGING INFECTIOUS DISEASES: Zoonoses (Rabies), </li></ul><ul><li>Dogs are recognized to play a role in about 100 zoonotic diseases ( WHO, 1987; WHO/WSPA, 1990 ). </li></ul>

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RESEARCH QUESTION ? <ul><li>Endemic canine rabies is a reemerging neglected zoonosis often underestimated in Kenya but remains a public health and economic burden to the rural poor . </li></ul><ul><li>Understanding the transmission dynamics and spatial distribution of dog bites over specified time period can assist in assessment of risk factors, design of interventions to exposure and the estimation of rabies burden </li></ul>59.5% 40.5% 83% 10% 5% 2% Kaare at al , 2009

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<ul><li>1. To identify, spatially and temporally, high-risk zones of dog bites by specifically identifying; </li></ul><ul><li>a) The population at risk </li></ul><ul><li>b) Environmental & socio-economic risk factors. </li></ul><ul><li>2. Evaluate changes in this risk over time. in order to assist in planning in establishment of rabies vaccine clinics . </li></ul>AIMS OF STUDY

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<ul><li>Patterns of bites may be strongly associated with other measures of animal habitat and physiographic barriers that form corridors for animal movement such as forests and rivers. </li></ul><ul><li>We suspect that these patterns may emerge from simulations on heterogeneous landscapes using ecologically defined areas with a finer spatial resolution of the landscape. </li></ul><ul><li>Variables such as human population density may provide more information when the spatial distribution of humans is modeled at a finer spatial resolution than the township average . </li></ul>HYPOTHESIS H 0 , B d ≥E v H a , B d ≠E v

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<ul><li>148 dog bite incidents with children below 10 years being more involved (33.8%). </li></ul><ul><li>Most bites occurred on the lower extremities 124/148 (83.8 %). </li></ul><ul><li>1.0% of bites resulted in rabies and death after PET. </li></ul><ul><li>The retrospective analysis revealed a temporal increase in prevalence 7.9 % (P<0.05). (N= 6829). </li></ul><ul><li>Seasonal clustering in March and August with a mean monthly bite incidence of 22.44% , strongly associated with the breeding seasons of dogs hence increased aggressiveness </li></ul><ul><li>2008 had the highest mean monthly incidence of 30% </li></ul>DESCRIPTIVE STATISITCS AND CLUSTERING EFFECT

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<ul><li>Annual increase in reporting can be attributed to increased public sensitivity and awareness to Rabies through the veterinary department.. </li></ul><ul><li>The trend reflects the probable range with the given data, but the true level may actually be even higher because of lack of accurate denominator data </li></ul><ul><li>Clustering may be significant in isolation or purely a random phenomenon. </li></ul><ul><li>The map indicates that vaccination clinics (CPV) could be effective if they were spatially targeted(Lubao). </li></ul><ul><li>Disparities in the affordability and accessibility of post-exposure treatment and risks of exposure to rabid dogs result in a skewed distribution. </li></ul>

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<ul><li>Active animal bite surveillance studies are required to improve the estimates of the true burden of rabies in peri-urban settings </li></ul><ul><li>These methods should prove valuable in modeling disease dynamics where local propagation is affected by local geography.( Monte carlo simulation & Knox’s test ) </li></ul><ul><li>Small-scale active case detection studies are a good basis for improving regional and national-level estimates of rabies morbidity and mortality. </li></ul><ul><li>Use of spatial models to generate risk maps may be useful in formulation of specific plans to manage or control disease. </li></ul><ul><li>Although the current analyses are descriptive , they provide a basis for further epidemiological investigations into the spatio temporal aspects of the rabies endemicity. We hope that others may find this approach useful for application to other infectious disease systems. </li></ul>CONCLUSIONS